AccountId: 011433970860
ContactId: 49b69e9e-08f2-48c1-a8d6-cfbbe1b57ba0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364540 ms
Total Talk Time (AGENT): 221452 ms
Total Talk Time (CUSTOMER): 94771 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/49b69e9e-08f2-48c1-a8d6-cfbbe1b57ba0_20250307T20:20_UTC.wav
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[AGENT][NEUTRAL] Contacting APO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to check on the status to make sure their claim is on file.
[AGENT][NEUTRAL] Yes, I can look up the claim. Whom am I speaking please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Yeah thank you.
[CUSTOMER][NEUTRAL] I swear I think every time I call, I talk to you.
[AGENT][NEUTRAL] Oh really? Sorry.
[CUSTOMER][NEGATIVE] You're a busy woman. No, don't be sorry. I'm just like that poor lady needs some help.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, um, do you have the, the policy number that I can look up?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 024517887.
[CUSTOMER][NEUTRAL] M as in mother.
[CUSTOMER][NEUTRAL] L as in Larry.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Oh, thank you. So, and I know I have to ask, um, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][POSITIVE] Yeah [PII] and that's correct.
[AGENT][NEUTRAL] OK, thank you. Uh, what date of service were you looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And is there a bill amount that I should be looking for or?
[CUSTOMER][NEUTRAL] $975.
[AGENT][NEUTRAL] 975. OK, let's see what we've got here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I see where she's
[CUSTOMER][NEUTRAL] Well you probably don't have one on file.
[AGENT][NEUTRAL] Yeah, I see where she's tried to submit some claims. I just don't see where, where your, where your uh provider has it. I just want, I just wanna look one other place here really quickly. I wanna see what this is because I think this is.
[AGENT][NEUTRAL] Yeah, I don't think, uh, I don't think I do have your claim now there is no timely filing I mean because you know we're the secondary and so there's no problem with that, um.
[AGENT][NEUTRAL] Yeah, OK, so I don't have your claim at all. So, uh, would you like to fax it in? Do you want to mail it in? Do you want to submit it by, uh, well, mail takes a while, but if you don't mind that.
[CUSTOMER][NEUTRAL] Pony Express, no, I'll fax it if you don't mind.
[AGENT][NEUTRAL] That's about what it is.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] If you do that, you might, you might, you know, just sling it in the air and we'll get there as fast, um, but yes, um, so you do have our mailing address.
[CUSTOMER][NEUTRAL] Let me see, let me get back to.
[CUSTOMER][NEUTRAL] Alright, can I have both? like what's the mailing address? So it's APL claims department?
[AGENT][NEUTRAL] Yeah, so the mailing address is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] Oh [PII], I had the worst time spelling [PII]. Can you help me?
[AGENT][NEUTRAL] Uh, yeah, sure. Um, it's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And um the abbreviation for the state is [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And uh then our zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Now, our fax number, and I, I usually will see the fax for the very next day if you if you wanted to do that, um, it's [PII].
[AGENT][NEUTRAL] 3365.
[AGENT][NEUTRAL] 9423. Now we, we also have an online service center. Would you be interested in that? If you can actually submit the claims we can see them in real time and.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Well, I can't do it because I never have the um the last four of the patient's social security number.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Uh, uh, OK, OK, yeah, OK, that's, well, anyway, the, the fax is good. I mean, that's, that's always a good way to get us and, and that way you can, um, and you can fax it and mail it that way, you know, you can just, if you want to do that and then that way we can, we can put the paperwork together and, you know, process the one that we get first. Now, is this the only date that we're looking for for this lady or?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, well, no, it looks like.
[CUSTOMER][NEUTRAL] I don't think you have that one either, um, [PII].
[AGENT][NEUTRAL] What, what is it?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of this year. OK, yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And um, is that, uh, what is that for?
[CUSTOMER][NEUTRAL] $175.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK. Um, now, she tried to submit this herself, um, but this is for an office visit, so, um, I don't have your copy of it, but I'll just tell you ahead of time that the, that the policy doesn't, um, cover office visits. It covers the treatment within the physician's office and procedures, but that office visit co-pay is not covered. But if you want to, you can just submit it all at once and if you, you know, you just need a denial for it, we can do that.
[CUSTOMER][NEUTRAL] Can I submit um both of them in the same fax?
[AGENT][NEUTRAL] Please, yes, that would be fine. No, no, no, do them all in, in the same one and then that way we'll separate them, but that's fine, they'll, they'll both get processed.
[CUSTOMER][NEUTRAL] Or should I do them? OK.
[CUSTOMER][NEUTRAL] And then does her policy cover her primary deductible?
[AGENT][NEUTRAL] Yes, so for outpatient services, it's a per calendar day, um, that's $1000 per calendar day, um, just a verification, not a guarantee of payment, but yes, it's a deductible, the co-payment on treatment and procedures or the co-insurance that the only thing really that, that would not be covered would be that, that office visit co-pay. Everything else, you know, we, we do labs, um, durable medical, um, but it's just that, that office visit isn't covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well I will fax these over.
[CUSTOMER][POSITIVE] Get back in just a moment and thank you so much for your help. Do you provide reference numbers?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] OK alright well thank you so much I hope you have a good weekend.
[AGENT][POSITIVE] Mhm. Thanks for contacting UP. You have a very good day